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Residents Forum at CAP ‘11

Residents Forum at CAP ‘11. Saturday, September 10, 2011 Grapevine, Texas Morning Joint Session with House of Delegates Residents Forum Morning Session Joint Lunch sponsored by PathPAC Residents Forum Afternoon Session. NewsPath™. CAP publication Articles are: 500 words Peer-reviewed

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Residents Forum at CAP ‘11

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  1. Residents Forum at CAP ‘11 Saturday, September 10, 2011 Grapevine, Texas • Morning Joint Session with House of Delegates • Residents Forum Morning Session • Joint Lunch sponsored by PathPAC • Residents Forum Afternoon Session © 2011 College of American Pathologists. All rights reserved.

  2. NewsPath™ • CAP publication • Articles are: • 500 words • Peer-reviewed • Newsworthy • Visit: cap.org/newspath • Junior Members: • Write articles with mentors • Get on iTunes • Join RSS Feed • Blog/Retweet @pathologists © 2011 College of American Pathologists. All rights reserved.

  3. Betsy D. Bennett, MD, PhD, FCAP Executive Vice President American Board of Pathology (ABP) William F. Hickey, MD, FCAP CAP Governor Henry M. Rinder, MD, FCAP American Society for Clinical Pathology (ASCP) Resident In-Service Examination (RISE) Committee Chair Suzanne Z.E. Powell, MD, FCAP APC Program Directors Section (PRODS) Chair Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee Chair Michael L. Talbert, MD, FCAP CAP Graduate Medical Education Committee Chair Association of Pathology Chairs, Inc. (APC) Representative Town Hall © 2011 College of American Pathologists. All rights reserved.

  4. RISE correlation with ABP outcomes 454 residents graduating in 2008 424 graduating in 2009 All were first-time takers of 2008 and/or 2009 ABP certifying examinations in AP and/or CP All had evaluable data from their senior RISE in spring 2008 or 2009 We correlated RISE scores with pass/fail results on AP/CP certifying exams Appears in Oct AJCP issue

  5. 2008 AP RISE sections P=0.07 *P<0.001 *P<0.001

  6. 2008 CP RISE sections *P<0.001 for all

  7. RISE quartiles & pass rates for ABP Fewer than half of 2008 graduating residents in the bottom quartile passed all of their certifying examinations. In a post-hoc analysis, we found that slightly more than two-thirds (69%) of 2008 graduating residents who were in the lowest quartile for the 2008 RISE were also in the lowest quartile for their 2007 (junior) RISE scores

  8. Conclusions RISE and most sectional mean scores were between 45 to 75 points higher for those passing the certifying examinations but even greater gap in Surgical Pathology section Passing rates for the certifying examinations declined with each quartile of overall RISE scoring RISE scores under the 50th percentile – some risk of failing a certifying exam Bottom quartile of RISE results – definitely an at-risk group for failing Junior year’s RISE results – may identify 2011 Fellowship/Job Market Survey results: www.ascp.org/residents

  9. Newly Elected RFEC Members • Chair • Nicole Riddle • Vice Chair • Roseann Wu • Secretary • Christine Jabcuga • Alt Del to AMA RFS • Daniel Wimmer • Alt Del to CAP HOD • Erin Consamus • Member-at- Large • Lauren King © 2011 College of American Pathologists. All rights reserved.

  10. Continuing RFEC Members • Immediate Past Chair • Jerad Gardner • Del to AMA RFS • Crystal Trujillo • Del to CAP HOD • Ricardo Mendoza © 2011 College of American Pathologists. All rights reserved.

  11. Interactive joint sessions at meetings Speaker panel Round table discussion Networking reception at meetings More residents involved in HOD AGs HOD/RF and Networking © 2011 College of American Pathologists. All rights reserved.

  12. ACGME Duty Hours Met with members of ACGME and Pathology RRC Led discussions on Wiki and via email on how to implement new duty hours guidelines New goals to be decided based on residents’ concerns Examples to of how programs are implementing ACGME changes to be posted on Wiki Training Program Issues © 2011 College of American Pathologists. All rights reserved.

  13. ACGME does allow Requires proper documentation CMS does technically allow Only non-provider sites (???) Or fill out official paperwork CMS does not allow just leaving your institution unofficially. Options If program has more residents than allotted – Not CMS funded Vacation/sick leave (last resort!) Remember Numerous grants available CAP, ASCP, and independent labs External Electives © 2011 College of American Pathologists. All rights reserved.

  14. Spring 2012 AP/CP Exams: www.abpath.org - PATHway Registration opens Sept 2011 Final filing date Jan 15, 2012 Final late filing date Feb 15, 2012 Program Director approvals and evaluations due Feb 1, 2012 Date assignments Mar 2012 Cancellations Exams begin May 14, 2012 Results posted 4 to 6 weeks after the final week of examinations Board Prep: Application © 2011 College of American Pathologists. All rights reserved.

  15. Complete training by July 1 for the spring exam and November 1 for the fall exam. Hold a non-restricted medical license. 50 autopsies Age, sex, primary diagnosis, and date performed Change for 2013 exam: Fetopsies Autopsy consent, intact fetus, placenta included No more than 5 IUFD only, no more than 2 macerated Board Prep: Requirements © 2011 College of American Pathologists. All rights reserved.

  16. AP Lefkowitch Anatomic Pathology Board Review Osler Pathology Board Review Course  Surgical Pathology Unknown Conference CP Osler Pathology Board Review Course ASCP Resident Review Course Koneman’s Color Atlas and Textbook of Diagnostic Microbiology Board Prep Survey: Top 3 Resources © 2011 College of American Pathologists. All rights reserved.

  17. Osler Pathology Board Review Course ASCP Review Course 47.9% took a review course. 60% recommend using resources from a review course. 1 to 6 months prior to the exam Familiarize yourself with virtual microscopy! Board Prep Survey: Review Courses © 2011 College of American Pathologists. All rights reserved.

  18. Start of residency Logs Daily education 6 months prior Study in earnest Turn in app 1 week of assignment date Reservations 4-6 weeks after Receive results Need full license Board Prep Timeline © 2011 College of American Pathologists. All rights reserved.

  19. Airports Tampa International St Pete/Clearwater Orlando Ground Transportation Hotel shuttle, car rental Arrive the day before, or earlier InterContinental Hotel Recommended hotel, connected to test site ABP rate Ramada Westshore Tampa Board Travel:Transportation and Hotel © 2011 College of American Pathologists. All rights reserved.

  20. Photo ID ABP-provided blue exam ID card Board Exam: Necessities © 2011 College of American Pathologists. All rights reserved.

  21. Board Exam Bring to cubicle Earplugs Facial tissue Polarizers Layered clothing Bring to exam center • Cell phone, pager, laptop • Drinks • Food/snacks • Medications © 2011 College of American Pathologists. All rights reserved. © 2011 College of American Pathologists. All rights reserved. 22

  22. Board Exam: Virtual Tour © 2011 College of American Pathologists. All rights reserved.

  23. ABP blue ID card on desk Blank paper for notes/calculations Microscope Adjustable chair Sample questions Time Management: Prepare early/schedule/plan. Answer questions you know first. Save calculations for last. Watch time/pace yourself. Go fast. Some had no issue with time. Board Exam © 2011 College of American Pathologists. All rights reserved.

  24. Keep contact information updated on ABP website! Time Limited Certificates Maintenance of Competence CME After the Board Exam © 2011 College of American Pathologists. All rights reserved.

  25. Decreasing Hospital Autopsies Burton, JL and Underwood, J, “Clinical, educational, and epidemiological value of autopsy.” Lancet 2007, 369:1471-80. De Vlieger, GYA, et al. “Clinical review: What is the role for autopsy in the ICU?” Critical Care 2010, 14:221. Hull, MJ, et al. “Resident physician opinions on autopsy importance and procurement.” Human Pathology 2007, 38: 342-350. © 2011 College of American Pathologists. All rights reserved.

  26. 2010 Survey to PRODs 2011 Survey to Residents & Fellows April 2011 206 surveys completed by junior panel members 90% confidence that responses were +/- 5% accurate Autopsy Survey Methods © 2011 College of American Pathologists. All rights reserved.

  27. 20% First Year Residents 16% Second Year Residents 13% Third Year Residents 11% Fourth Year Residents 40% Fellows 79% work in university hospitals. 14% work in community hospitals (university affiliated). 2011 Autopsy SurveyParticipants' Profile © 2011 College of American Pathologists. All rights reserved.

  28. The majority of the participants received 4-5 months of Autopsy (including forensics) during their residency training. Who obtained the autopsy permit? Decedent affairs: >41% Resident: 31% Overall, 80% felt that they had sufficient training to perform autopsies in clinical practice. About 50% agreed or strongly agreed that if they were to perform less than 50 autopsies, they would still be competent. Autopsy Survey Results © 2011 College of American Pathologists. All rights reserved.

  29. About 58% did not share autopsies. 68% strongly disagreed or disagreed that sharing cases lead to inadequate autopsy skills. 74% stated that sign out was with faculty non-boarded in forensics. 81% agreed or strongly agreed that they could easily meet the ACGME requirement at their institution. Most stated that 50 autopsy requirement could be maintained. 31% wanted the requirement decreased to less than 50. 21% wanted it eliminated. Autopsy Survey Results © 2011 College of American Pathologists. All rights reserved.

  30. “[Autopsy's] value as a clinical service is over-emphasized. Residency training is short and with only 4 years to become competent in general surg path, cytopath, heme path, derm path, clin path, etc, 6 months is too much time....” “I think that autopsies will continue to decrease and eventually be replaced with whole body CT scanning with minimally invasive autopsies and limited tissue sampling.” “The number of cases should remain at 50. If programs are having difficulties attaining that number, lobbying should be done by pathology organizations to emphasize the need for autopsies so that appropriate funding can be obtained.” Selected Comments © 2011 College of American Pathologists. All rights reserved.

  31. Residents with significantly lower perception vs PRODs Ability to complete 50 autopsies at their institution Ability to perform autopsies as paramount to finding good employment Sharing autopsies results in residents with inadequate autopsy skills. Maintaining autopsies at or increasing the number to greater than 50 Results of 2011 vs 2010Autopsy Surveys © 2011 College of American Pathologists. All rights reserved.

  32. Residents with significantly higher perception vs PRODs Decreasing the number of autopsies to less than 50 If number were less than 50, should still be able to perform competent clinical autopsies Results of 2011 vs 2010Autopsy Surveys © 2011 College of American Pathologists. All rights reserved.

  33. Increase awareness through presentations, pamphlets with scripts for residents to use Develop interdepartmental Autopsy conferences Improve quality of report and make it more patient-friendly Survey clinician and patient attitudes toward autopsy Propose limited autopsy to patients Suggestions for Improvement © 2011 College of American Pathologists. All rights reserved.

  34. www.pathinfo.wikia.com © 2011 College of American Pathologists. All rights reserved.

  35. Directory of path residency/fellowship programs Goal: Complete and Up-to-date Links to program websites Reviews of programs Immunostain wiki Board prep info Pathology links Directory of private and academic practices Pathology Wiki (www.pathinfo.wikia.com) © 2011 College of American Pathologists. All rights reserved.

  36. Job Hunting and Contract Negotiations Panelists • Chad R. Rund, DO, FCAP Head of Gastrointestinal Pathology Services - Greensboro Pathology Associates, Greensboro, NCGeneral Surgical, Gastrointestinal and Liver Pathology (Private) • Miriam Post, MD, FCAP Assistant Professor, University of Colorado - Denver, CO Gynecologic and Obstetric Pathology (Academic) • Noel A. Brownlee, MD, PhD, FCAP Pathologist - Upstate Pathology, PA - Greenville, SC and Associate Professor of Pathology - VCOM Carolinas Campus Pulmonary, Urologic and Molecular Pathology – (Private + Academic) • Amanda E. Wehler, DO, FCAP Medical Director, Transfusion Medicine - Geisinger Medical Center, Danville, PA Transfusion Medicine (Private) • Jack R. Bierig, JD Sidley Austin, LLC, Chicago, IL General Counsel for CAP for 25 years, represents a number of pathology practices, teaches Health Law and Policy at the University of Chicago

  37. Job Hunting and Contract Negotiations 10 things to consider during job hunting: 1. How cutting edge is the work the group does?  A group that is in the forefront of new procedures is more likely to succeed. 2. How involved are they with the medical staff and administration?  A group that is involved is more likely to retain its relationships 3. How is the group compensated?  A group that is less dependent on the hospital for all its revenues is more likely to do well.

  38. Job Hunting and Contract Negotiations 10 things to consider during job hunting: 4. How entrepreneurial/innovative is the group?  A group that is looking for new business opportunities is also more likely to succeed. 5. What happened to young hires?  The experience of your predecessors is the best predictor of what will happen to you. 6. Will you be working at the main hospital or satellite location?  You should have an understanding of where your principal practice will be.

  39. Job Hunting and Contract Negotiations 10 things to consider during job hunting: 7. What percentage of your practice will be in the specialty of your choice?  You may want to know the extent to which you can specialize. 8. What are the salary and benefits? This point needs no explanation. 9. Try to get any "non-compete" clause removed or limited. You don’t want to be barred from practicing in the same area if things don’t work out.

  40. Job Hunting and Contract Negotiations 10 things to consider during job hunting: 10. What are the people like in the group? This is probably the most important point.  You want to work with good people whom you like and respect.

  41. Networking Tips • Break the ice • Make yourself memorable • Close the deal • Follow up • Use orange boldto emphasize text. • Avoid over-formatting. • Do not use all capital letters. © 2011 College of American Pathologists. All rights reserved.

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